Factors involved in diagnostic delay of testicular cancer

In testicular cancer, which is one of the highly curable cancers, the beneficial effect of early diagnosis on survival has been well accepted for years. This study was planned to determine the probable factors involved in diagnostic delay of testicular cancer. A total of 140 patients with testicular cancer were included in this study. We attempted to find a relationship between the mode of presentation, stage of the tumour, patients' socioeconomic status and the delay in diagnosis. Majority of patients presented with scrotal pain (49.3%). No significant correlation was found between the mode of presentation and stage of the disease (p>0.05). The median time of delay in diagnosis was 5.4 months. The stage at presentation was not influenced by the delay in diagnosis. Similarly the annual income and the educational level of the patients had no significant impact on the delay in diagnosis. No effect of delay in diagnosis on the stage at presentation could be demonstrated in our study. Our results indicate that in this country people are not thoroughly educated about the importance of routine self-examination of the testes. It must also be emphasized that painful testicular masses need to be evaluated carefully to rule out malignancy.

Nitric oxide biosynthesis and malondialdehyde levels in advanced breast cancer

BACKGROUND

Nitric oxide (NO) is a free oxygen radical studied in many tissues. Its tumour killing structure is shown especially by macrophages. The end products of NO are nitrite and nitrate. Their plasma levels are used biochemically to determine nitric oxide synthase (NOS) activity. The proliferative capacity of cancer cells accompanies the alteration in oxidant-anti-oxidant status. The risk of breast cancer is decreased in association with an increased level of polyunsaturated fatty acids in the erythrocyte membranes. The more the anti-oxidant capacity increases, the more the transformed cells grow. Malondialdehyde (MDA) is a lipid peroxidation marker, and low plasma levels of MDA are associated with advanced stages of breast cancer.

METHODS

In the present study, the alteration of serum plasma levels of nitrate, nitrite and MDA were determined in patients with stage IIIB breast cancer and controls.

RESULTS

It was found that products of NO biosynthesis were higher and plasma MDA levels were lower in patients with breast cancer.

CONCLUSIONS

It can be stated that in advanced breast cancer, the NO radical production is increased while the lipid metabolism is altered, and these changes can be related to an alteration in oxidant-anti-oxidant status.

Primary malignant lymphoma of the appendix (a case report and review of the literature)

Authors report a case of a 29-year-old male with primary malignant lymphoma of the appendix with involvement of lymph nodes in the mesenteries. Surgical intervention was performed, adjuvant chemotherapy was applied. No recurrences, metastases or complaints occurred after one year of follow-up. The case is of interest due to the clinical and histopathological diagnostic problems as well as the dimension of the metastatic lymph node in the ileal mesentery.

Occlusion of the MCA by an intraluminal filament may cause disturbances in the hippocampal blood flow due to anomalies of circle of Willis and filament thickness

We examined blood flow changes and histology in the hippocampus induced by occlusion of the middle cerebral artery (MCA) by a filament in Swiss albino and SV-129 mice (n=67) and in Wistar rats (n=64). Filling cerebral arteries with carbon black revealed that one or both posterior communicating arteries were hypoplastic in 50% of Swiss mice. Ischemic changes were detected in the ipsilateral hippocampus with 2,3,5-triphenyl tetrazolium chloride or hematoxylin and eosin staining when these mice were subjected to 2-h MCA occlusion and 22-h reperfusion. No such abnormalities were found in SV-129 mice and Wistar rats (except one). The hippocampal blood flow dropped to 60+/-2.3% of the baseline in mice with a normal circle of Willis but to 37+/-4.2% in those with an incomplete circle when the MCA was occluded with a 6/0 nylon filament. When an 8/0 filament was used, no flow change in mice with a normal circle but a decrease to 60+/-2% in those with an incomplete circle was observed. A flow drop to 63+/-4% was also seen in Wistar rats when a 3/0 filament used. These data demonstrate that occlusion of the MCA by a thick filament may cause flow reduction in the hippocampus, which may be severe enough to lead to infarction if the circle of Willis is anomalous.

Are postoperative drains necessary with the Limberg flap for treatment of pilonidal sinus?

PURPOSE

Different methods for managing pilonidal sinus have been described in the literature. Our purpose was to evaluate the influence of postoperative drainage in Limberg flaps.

METHODS

Forty patients with pilonidal sinus undergoing radical excision and reconstruction with Limberg flap between 1994 and 1996 were evaluated prospectively. After patients were assigned randomly to the two groups, the effects of drains were studied statistically in terms of wound complications, hospital stay, and recurrence rate.

RESULTS

Except for two minor transient wound dehiscences, in all cases primary healing was achieved. Early wound complication rate was 7.5 percent and recurrence rate was 2.5 percent for both groups. There was no significant difference between the groups in early wound complications (P > 0.05). The length of hospital stay was significantly longer in the drainage group (P < 0.001).

CONCLUSION

We conclude that Limberg flaps with no drains in place will result in shorter hospital stays without deleteriously affecting the surgical results of wide excision and primary closure with well-vascularized tissue.

The management of hepatic hydatid cysts: review of 94 cases

In this retrospective study, 94 patients operated for hepatic hydatid cysts were reviewed to compared the advantages and disadvantages of different operative techniques. The patients were divided into four groups according to the type of operation. Group I consisted of 33 patients with peripherally located small cysts, eligible for excision, who underwent cystectomy. Group II consisted of 28 patients with cysts smaller than 5 cm, not suitable for complete removal, who underwent partial cystectomy with capitonnage. Group III were 21 patients with cysts larger than or equal to 5 cm, not suitable for complete removal, who underwent partial cystectomy with omentoplasty. Infection and biliary communication were not seen in groups II and III. Group IV were 12 patients with infected cyst or intrabiliary rupture who underwent partial cystectomy with external drainage. In group IV, hospital stay was longer than in the other groups (P < 0.05). Group I had the shortest hospital stay (P < 0.05). Group IV had the highest morbidity and recurrence rates (P < 0.05). We concluded that cystectomy is the technique of choice in selected patients, as it is associated with low morbidity, low recurrence rates, and short hospital stay. Omentoplasty is preferred if cystectomy is not feasible. If there is biliary contamination and infection, external drainage, rather than omentoplasty, should be performed.

Testicular effects of vasectomy in rats: an ultrastructural and immunohistochemical study

OBJECTIVES

The correlation between infertility and morphofunctional alterations following vasal occlusion is not clearly understood. Although a correlation has been found between the expression of a high titer of antisperm antibodies and the status of infertility, the relationship between the immunoglobulin (Ig) depositions in the testis and ultrastructural alterations of the peritubular structures has not been clearly established. The objective of this study is to explain the etiopathogenesis of diffuse and focal testicular lesions caused by vasal obstruction.

METHODS

Unilateral vasectomy was performed on adult male rats. Ultrastructural changes of testicular tissues and immunostaining affinity of peritubular structures with anti-actin, anti-vimentin, anti-laminin, and anti-immunoglobulin G (anti-IgG) antibodies were analyzed.

RESULTS

In an ultrastructural study, vasectomized animals presented abundant collagen fibril accumulation in the peritubular area. In testis with intense IgG antibodies, staining revealed weak immunostaining of peritubular myoid cells with anti-actin antibodies, but intense immunostaining with anti-vimentin antibodies. The tubules of rats with no IgG deposition on peritubular structures revealed intense immunostaining with anti-actin antibodies but scant immunostaining with anti-vimentin antibodies. Anti-laminin deposits decreased severely in most of the tubules demonstrating intense IgG deposition.

CONCLUSIONS

Our findings suggest that spermatogenesis deteriorates more severely in testes with dense IgG deposition. The sclerosis of the lamina propria in cases with vasal occlusion is secondary to alterations in the peritubular myoid cells. With the progressive changes that occur in the peritubular myoid cells or differentiation of the peritubular myoid cells that acquire active cell characteristics, collagen accumulation adjacent to these cells increases markedly. The alterations of the peritubular myoid cells reported here may be caused by alterations in basement membrane structures.

Lymphangiomas of the ileum: a report of two cases and a review of the literature

Lymphangiomas of the gastrointestinal tract are seen very rarely, especially in adults. We herein present two cases of ileal lymphangioma which were found during surgery. One case was a 43-year-old man with a palpable mass, and the other was a 19-year-old man who presented with symptoms of pyloric stenosis. Although radiologic studies helped us, we could only be certain about the diagnosis after both the operation and histopathologic studies. We performed a total excision with ileal resection in both cases.

The effectiveness of low molecular weight heparin on adhesion formation in experimental rat model

In our experimental animal model, 50 Winstar-Albino rats were divided into five groups in a randomized manner. After all were anesthesized with ether, laparotomy was performed on each one and the caecum and terminal ileum were scrubbed with a toothbrush until serosal petechial bleedings were seen. In the first group, the abdomen was closed after this procedure. In the second group, the abdomen was closed after application of 0.9% NaCl solution intraperitoneally. In the third group, the abdomen was closed after LMWH (low molecular weight heparin) was given intraperitoneally. In the fourth group, LMWH was given in prophylactic dosage subcutaneously on the day of operation and for the following seven days. In the fifth group, abdomen was closed after heparin was given intraperitoneally. On the fourteenth postoperative day, the rats were sacrificed and intraperitoneal adhesions were scored according to the "Mazuji's Scale". There was a statistically significant difference between group I and group III. No statistically significant difference could be found between group I and group IV (p > 0.05). Between group I and V a statistically significant difference was found (p < 0.005). Again a statistically significant difference was found both between group III and IV (p < 0.05), and between group IV and V (p < 0.001). No such difference was observed between group IV and V (p < 0.05). As a result, in this animal model, LMWH given intraperitoneally to prevent adhesions was found to be more effective than subcutaneous and intraperitoneal heparin application.

Intracranial calcification in children on computed tomography

Pathological intracranial calcifications detected on computed tomography of 83 children during a six-year period were reviewed. The common causes in our series were tuberous sclerosis and intracranial tumors. Other conditions associated with calcification were Sturge-Weber syndrome, neurofibromatosis, Cockayne's syndrome, hypoparathyroidism, arteriovenous malformations, vein of Galen aneurysm, encephalomalacia, cerebral infarcts, subdural hematoma, cerebral infections, birth asphyxia and dihydropteridine reductase deficiency. In two cases (2%), calcifications were idiopathic. The distribution and location of the calcifications in these conditions are discussed.

Cerebellar ataxia associated with hypogonadotropic hypogonadism and chorioretinopathy: a poorly recognized association

We report a male with cerebellar ataxia, hypogonadism and chorioretinopathy. The age of onset was 12. The parents were first cousins. Endocrinologic studies demonstrated hypogonadotropic hypogonadism due to pituitary dysfunction. The ocular disorder involved the choriocapillaris and the retina. The association may represent a separate syndrome, seldom recognized in the past.

Gadolinium-enhanced MRI in cerebral Whipple's disease

Confusion developed in a 44-year-old man, who had diarrhoea and weight loss for three months. Jejunal biopsy showed infiltration by PAS-positive macrophages, indicating Whipple's disease. Cranial MRI disclosed multiple lesions mainly in the white matter and grey-white matter junction better demonstrated after gadolinium injection.

Cerebral fat embolism studied with MRI and SPECT

In a patient with fat embolism to the brain CT showed no abnormality. MRI performed after recovery from coma, when the patient had aphasia and quadriparesis, demonstrated multiple high signal abnormalities in the white matter on both T1- and T2-weighted images. HMPAO-SPECT showed left-sided hypoperfusion which resolved in parallel with clinical improvement 1 month later.

Gadolinium-enhanced MRI in central nervous system Behçet's disease

Two cases of central nervous system Behçet's disease, studied by gadolinium-enhanced MRI, are presented. In one patient, whose clinical picture was dominated by a brain syndrome, the gadolinium enhancement resolved with clinical improvement, although the hyperintense areas in the mesencephalon on T2-weighted images persisted. In the second, who had a pseudobulbar palsy and a mild right hemiparesis, there were many abnormal areas, but an enhancing focus in the posterior limb of the left internal capsule was probably the lesion responsible for the hemiparesis.

Post-thyroidectomy hypocalcemia: does arterial ligation play a significant role?

To assess the possible role of truncal ligation of inferior thyroid arteries on post-thyroidectomy hypocalcemia, a prospective study was carried out on 80 patients. Bilateral subtotal thyroidectomy was performed for non-toxic nodular goiter in two groups. Inferior thyroid arteries were ligated bilaterally in 50 patients but not ligated in 30 patients. In both groups mean serum calcium levels on the first and second postoperative days were found to be significantly lower than preoperative levels. However these falls were similar in both groups. We conclude that bilateral truncal ligation of inferior thyroid arteries is not a factor that may cause hypocalcemia due to vascular insufficiency of parathyroid glands.

Eales disease with internuclear ophthalmoplegia

Eales disease is an idiopathic type of retinal perivasculitis characterized by recurrent retinal and vitreous hemorrhages. Neurologic involvement is rare. We report the case of a patient with Eales disease who had internuclear ophthalmoplegia thought to be a neurologic manifestation of this disease.

Hot water epilepsy

The clinical and EEG features of 10 patients with hot water epilepsy were presented. Eight of the 10 cases were male. The mean age of onset was 4.7 years. In four patients partial and in six cases generalized seizures were seen. Three patients also had non-hot water precipitated seizures. Interictal EEGs showed generalized abnormalities in eight and focal abnormalities in two cases. CT was performed and found normal in two patients. Anticonvulsant therapy was instituted for all patients. In six cases with adequate follow-up, complete remission was obtained in four and the frequency of the seizures was decreased in two, with anticonvulsant therapy.

Fascicular oculomotor nerve palsy in neuro-Behçet's disease

A 43-year-old man with Behçet's disease developed a left oculomotor palsy and a right elevation paresis. His clinical picture was consistent with an isolated fascicular third cranial nerve palsy, considering the mass effect of a large left capsulothalamic lesion extending down into the mesencephalon, which was visualized by CT and (more precisely) by MRI. The patient's clinical status was improved with steroid and immunosuppressive therapy, and radiologic abnormalities resolved markedly in a month.

Left occipital hypoperfusion in a case with the Asperger syndrome

The Asperger syndrome, a less severe variant of autism, has drawn increasing interest among child psychiatrists. Cerebral blood flow studies with autistic subjects have failed to reveal consistent findings. We are reporting a case with the Asperger syndrome, whose single photon emission computed tomography showed left occipital hypoperfusion.

[Parallax technics]

Regarding radiologic interpretation, parallax determines the different x-ray appearance of the same objects from various exposuring directions. In the present study the horizontal and vertical shift sketch method is used. This study is carried out on 31 patients admitted to Oral Diagnosis and Radiology Department. After recording the location of impacted teeth to the special forms, surgical intervention is performed. The susceptibility of this study is found 100 per. cent. Only in one mesio-dens case we had an conflict. This finding is also being discussed. The sophisticated details of the method is being described.